Lake Chad: trapped in deadly violence

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One of Africa’s biggest humanitarian crises is currently ongoing in the Lake Chad basin. Millions are being displaced and in response, Doctors Without Borders (MSF), is significantly scaling up its medical activities and assistance to people in the region.

With over 2.7 million people uprooted from their homes, the Lake Chad basin is reaching breaking point. This is due to attacks by the Islamic State’s West Africa Province group (ISWAP), also known as Boko Haram, and a strong military response which has been launched to curb the violence.

The conflict originally stemming from Nigeria has spread across borders to Cameroon, Chad and Niger, causing widespread displacement and suffering. Indiscriminate violence perpetrated by armed belligerents from all sides has direct consequences for the already vulnerable civilian population.

Falmata, aged 45, lives alone with her eight children in a refugee camp in southern Niger after fleeing her village in northern Nigeria, during a violent attack by Boko Haram. “When Boko Haram came to our village, they were shooting in all directions. I counted 18 bodies around me but we managed to escape. We arrived here with empty hands, we had no time to take anything.”

Thousands of people have fled their villages on islands in Lake Chad, in south-eastern Niger.
Photo: MSF

Isabelle Mouniaman, MSF Programme Manager for Nigeria, says the violence is only serving to aggravate a pre-existing crisis. “This region is already suffering from poverty, extreme vulnerability, food insecurity, recurring disease outbreaks and an almost non-existent health system,” she explains. “People are in need of basic amenities such as food, water, shelter and healthcare.”

Many of the displaced have found refuge with residents of communities they’re in, putting strain on already limited resources. State services, already running at low capacity, as well as agricultural activities and cross-border trade have been dangerously disrupted.

To address the crisis, MSF is greatly increasing its support to the Lake Chad region through various interventions, including treating malnutrition and malaria and providing water and sanitation services among other initiatives.

Nigeria
Since 2014, around one million people - the large majority of whom live without sufficient food, clean water or adequate health services - have sought refuge from violence in Borno state in north-eastern Nigeria.

“We need more support,” says Chibuzo Okonta, MSF Emergency Project Manager. “We have repeatedly called on other humanitarian and aid organisations to assist displaced people in Borno state but the appeal has gone unanswered.”

In the state capital, Maiduguri, MSF teams support Ministry of Health centres in Maimusari and Bolori, assisting deliveries and providing treatment for malnutrition and malaria.

Last September, MSF began managing the emergency room in Maiduguri’s Umaru Shehu Hospital, where an MSF surgeon now also carries out trauma surgery - in many cases for people wounded in violent attacks. MSF also monitors sanitary and health conditions in 15 camps that currently house some 100,000 internally displaced people (IDPs). In nine of these camps, MSF has trucked in clean water, drilled boreholes, constructed latrines as well as installed water pipes and tanks.

In Yobe state, 195, 000 people have fled violence and settled in various communities and four camps in the area. MSF teams performed over 4000 consultations in a health centre during January and February 2016. Last year, 240,000 litres of water were supplied daily in the camps and MSF has been treating children for malnutrition in Damaturu hospital since February.

Although not much attention is given to the crisis unfolding in the Lake Chad basin, the region continues to witness violence, displacement and food insecurity.
Photo: Louise Annaud

Cameroon
In the Far North region of Cameroon, there are currently 61,000 refugees and 158,000 IDPs and returnees. The majority of IDPs live in areas that receive little humanitarian assistance and which have few functioning health facilities.

“The situation is very volatile with increasingly frequent suicide bombings, attacks and military counteroffensives, trapping the population in the middle,” says MSF Head of Mission Hassan Maiyaki. “Security is a major obstacle for the provision of aid in this area, but we are doing what we can to scale up our activities.”

Since February 2015, MSF teams have been providing essential healthcare services to displaced and local populations in different locations in the region. Included in these are the provision of paediatric and nutritional care to the displaced and resident populations in Mokolo and Mora. Children under five are treated at the district hospital in Kousseri, where teams also provide surgical support, including caesarean sections. MSF is also offering support to local health authorities in response to large influxes of people wounded in violent attacks.

In addition to this, MSF is delivering medical care and water and sanitation activities at the UNHCR-managed refugee camp in Minawao. Currently, MSF is supplying 55 percent of the water in the camp and performed 29, 077 consultations there in 2015.

Chad
About 6,300 Nigerian refugees and 43,800 displaced Chadians are struggling to survive in the face of insecurity in the Lake area.

Federica Alberti, MSF’s Head of Mission in Chad, says that the situation remains unpredictable. “On top of high insecurity, people face dire health conditions such as recurrent peaks of malnutrition and malaria and a high risk of epidemics,” he explains. “As people continue to flee their homes, pressure is being placed on precarious food resources and an already weak health system.”

MSF has been working in Chad’s Lake area for a year now. MSF teams in the towns of Baga Sola and Bol provide basic healthcare to the displaced and resident populations through mobile clinics. In Bol, the organisation works with local health authorities to provide maternal and child healthcare at the district hospital.

New pockets of displaced people are gathering in Djamaron, around 100 kilometres from Baga Sola. In response, MSF launched new mobile medical activities to reach this vulnerable population in February.

Other available support includes psychologists providing mental healthcare in MSF’s mobile clinics as well as in the Dar es Salaam refugee camp.

A further MSF activity is distributing relief items - in January, teams provided kits containing plastic sheeting, mosquito nets, soap, towels and blankets to some 2,600 people and water treatment kits were handed to 500 families.

Mariam Ahian, 35, from Gama is visiting the MSF mobile malnutrition clinic for the first time.
Photo: Charlotte Morris

Niger
Over 300,000 Nigerian refugees, internally displaced and returnees have sought refuge in Diffa, southern Niger, due to continued violence in the area.

“The already vulnerable situation of the population in Diffa, who are facing current peaks of malnutrition and malaria, has further deteriorated due to the ongoing violence,” said MSF Programme Manager Luis Encinas. “Our patients are increasingly describing a devastating situation.”

People are living in very precarious conditions and basic needs such as shelter, food, clean water and access to medical care remain unmet.

In response, MSF is carrying out various interventions, including supporting the main maternal and paediatric health centre in Diffa and working in the district hospital in Nguigmi and several health centres in its surrounding areas.

In Yebi, some 30,000 people have sought refuge. In Assaga Camp, MSF has conducted a measles vaccination campaign, while also providing medical care and water and sanitation services. MSF carried out over 142,000 medical consultations in the region in 2015.

MSF began its emergency intervention in the Lake Chad region in 2014 and is currently present in several locations in Nigeria, Cameroon, Niger and Chad. MSF employs 1,223 staff in its projects throughout the region.